Lu KY, Lin FS, Lin CS, Lao HC. Percutaneous cervical cordotomy for managing refractory pain in a patient with a Pancoast tumor: A case report. World J Clin Cases 2024; 12(21): 4770-4776 [DOI: 10.12998/wjcc.v12.i21.4770]
Corresponding Author of This Article
Hsuan-Chih Lao, MSc, Chief physician, Director, Department of Anesthesiology, MacKay Memorial Hospital, No. 92 Sec.2, Zhongshan N. Road, Zhongshan District, Taipei 10449, Taiwan. hclao4799@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kuan-Yu Lu, Chia-Shiang Lin, Hsuan-Chih Lao, Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
Feng-Sheng Lin, Department of Anesthesiology, National Taiwan University Hospital, Taipei 10002, Taiwan
Chia-Shiang Lin, Department of Anesthesiology, Shuang-Ho Hospital, Taipei 23561, Taiwan
Hsuan-Chih Lao, Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11203, Taiwan
Hsuan-Chih Lao, Department of Medicine, MacKay Medical College, Taipei 23245, Taiwan
Author contributions: Lu KY, Lin FH, Lin CS, and Lao HC participated in the clinical treatment of the patient; Lu KY and Lao HC wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The author has read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsuan-Chih Lao, MSc, Chief physician, Director, Department of Anesthesiology, MacKay Memorial Hospital, No. 92 Sec.2, Zhongshan N. Road, Zhongshan District, Taipei 10449, Taiwan. hclao4799@gmail.com
Received: March 26, 2024 Revised: May 15, 2024 Accepted: May 30, 2024 Published online: July 26, 2024 Processing time: 95 Days and 17.4 Hours
Abstract
BACKGROUND
According to the World Health Organization analgesic ladder, cancer-related pain generally begins with pharmacotherapy in a stepwise approach. Nevertheless, some patients continue to experience poorly controlled pain despite medications, particularly when considering adverse effects and self-care quality. Percutaneous cervical cordotomy is an alternative interventional procedure for unremitting unilateral intractable cancer-related pain.
CASE SUMMARY
The patient was diagnosed with lung cancer with destruction of the brachial plexus and ribs. For 2 mo, the patient experienced progressive severe weakness and pain in the right upper extremity. Notably, the pain intensity reached an extreme level, particularly when lying supine, even under heavy sedation. This heightened pain response posed a significant challenge; as a result, the patient was unable to undergo further evaluation through magnetic resonance imaging. Ultimately, he underwent percutaneous cervical cordotomy for symptom relief, resulting in complete resolution of right arm pain. After a 3-mo follow-up, the pain did not recur, and only a flurbiprofen local patch was required for mild scapular tightness.
CONCLUSION
Cordotomy, under careful patient selection, appears to enhance the quality of life of patients with unilateral cancer-related pain.
Core Tip: Percutaneous cervical cordotomy provides a valuable alternative for the management of intractable cancer-related pain resistant to analgesics. The presented case involves a patient with advanced bronchogenic carcinoma experiencing severe upper limb pain and restricted range of motion. Conscious sedation ensures a comfortable and safe procedure. After cordotomy, the patient experienced relief from cancer-related pain without relying on opioids, significantly improving his quality of life.
